Relationship of age to impulsivity and decision-making: A baseline secondary analysis of a behavioral treatment study in stimulant use disorders.

Since stimulant use disorders (SUDs) remain prevalent across the lifespan, cognition is an important area of clinical care and research focus among aging adults with SUDs. This secondary analysis of data from the National Drug Abuse Treatment Clinical Trials Network (CTN) study “Stimulant Abuser Groups to Engage in 12-Step (STAGE-12),” protocol CTN-0031, suggests that decision-making, verbal learning/memory, executive function, and set shifting are important cognitive domains to screen clinically and treat in aging adults with SUDs. Some suggestions are made on how clinical treatment providers can use these results in a practical way. A neurocognitive assessment might be considered standard at initial and periodic follow-up visits. Providers might also consider adding adjunctive treatments in patient treatment plans to directly remediate impaired cognitive domains (e.g., decision-making, executive function). Finally, by capitalizing on unimpaired cognitive domains, treatment providers might modify their treatment approach to compensate for impaired domains — for example, instead of totally relying on verbal modalities, a provider might also consider using a visual one (e.g., pictures, white board, computer screen) to convey information and compensate for a patient’s impairment in verbal learning/memory. Future directions include potentially conducting pre/post neuroimaging of frontal cortical regions in aging adults with SUDs, correlating neuroimaging findings with neurocognitive measures in aging adults with SUDs, and developing cognitively remediating treatments (pharmacological and/or non-pharmacological) specific to affected cognitive domains (e.g., decision-making, verbal learning/memory, executive function, set shifting) in aging adults with SUDs.

Related protocols: CTN-0031-A-1